Predictors of Outcomes in Fourth Ventricular Epidermoid Cysts: A Case Report and a Review of Literature

Chung, Lawrance K.; Beckett, Joel; Ong, Vera; Lagman, Carlito; Nagasawa, Daniel T.; Yang, Isaac; Kim, Won

doi:10.1016/j.wneu.2017.06.037

Cited by 7 publications

(17 citation statements)

References 37 publications

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“…found longer age and DOS as predictors of outcome. [ 21 ] In our study, increasing age has significantly higher chances of subtotal resections, probably due to chronic presence, leading to adherences to neurological structures. The mean age, however, did not significantly affect the outcomes.…”

Section: Discussionmentioning

confidence: 64%

“…Similarly, the percentage of cranial nerve dysfunctions and HCP was more in our study. [ 21 ] This difference is probably due to the inclusion of a higher number of patients for analysis in our study. Although fourth ventricular epidermoids fill up the fourth ventricle, HCP always does not occur.…”

Section: Discussionmentioning

confidence: 93%

“…included only 23 studies and 37 patients and excluded certain cases with substantial information. [ 21 ] Our analysis included 58 studies, including 131 patients, which was much higher than the mentioned study. Chung et al .…”

Section: Discussionmentioning

confidence: 99%

“…[ 24 48 ] Adherence of the capsule to vital neurological structures, especially with brainstem and its nuclei, often leads to subtotal resections. [ 1 12 21 24 25 ] Many surgeons prefer subtotal resection in such cases, but this analysis emphasizes the role of total resections. Authors do not debate the importance of patient safety during surgery, but total removal is often possible under neuromonitoring in selected cases with meticulous dissection.…”

Section: Discussionmentioning

confidence: 99%

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Fourth ventricular epidermoid cyst – Case series, systematic review and analysis

et al. 2021

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Background: Epidermoid cysts are extra-axial, pearly white avascular lesions mostly found in the cerebellopontine region. They are slow-growing and mostly become symptomatic when they attain significant size. They do occur at other anatomical locations, but fourth ventricle is a rare location. Three representative cases with their outcomes are described here. Methods: The systematic review was done with adherence to predefined criteria. The studied variables were age, gender, duration of symptoms (DOS), clinical features, hydrocephalus (HCP), extent of resection, postoperative complications, outcome, follow–up, and recurrence. Statistical analysis was done to identify predictive factors for outcome. Results: Final analysis included 58 studies containing 131 patients. The most common clinical feature was cerebellar dysfunction (93%). The most common cranial nerve involved was the abducens nerve ( n = 37, 28.46%). Preoperative HCP was present in nearly a third (35%) of patients. The outcomes were not different with age ( P = 0.23), gender ( P = 0.74), DOS ( P = 0.09), and HCP ( P = 0.50). Improved outcomes were associated with total resections ( P = 0.001), absence of preoperative cranial nerve dysfunctions ( P = 0.004), and presentation with features of raised intracranial pressure ( P = 0.005). Longer DOS (mean 76.74 months) was associated with significantly increased cranial nerve nuclei involvement ( P = 0.03). Aseptic meningitis was reported in 14.5% of cases. Recurrences were infrequently reported ( n = 9). Conclusions: Although the fourth ventricular epidermoid lesions are difficult to detect in an innocuous stage, when found, they should be extirpated early and totally, as a longer DOS leads to cranial nerve dysfunctions and suboptimal outcomes.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Fourth ventricular epidermoid cyst – Case series, systematic review and analysis

et al. 2021

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“…1,4,6,9,15,20,22 In the sellar/suprasellar region, the differential diagnosis of EC includes dermoid cysts, craniopharyngioma, enterogenous cyst, neuroglial cyst, arachnoid cysts, endodermal cyst, Rathke cleft cyst with extensive squamous metaplasia, eventually metastatic well differentiated squamous cell carcinoma, and mature teratoma. [4][5][6]9,11,15,20,23,24 Dermoid cysts (DCs) arise more commonly in the midline of infants, being related to fontanel, the fourth ventricle, or the spinal canal. Dermoid Cyst (DM) exhibit a thick wall and contain adnexal structures, such as hair follicles and sebaceous glands.…”

Section: Discussionmentioning

confidence: 99%

Physiopathological Aspects of Sellar Epidermoid Cyst Determining Endocrine Disturbances: A Case Report

et al. 2019

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Epidermoid cysts (ECs) of the central nervous system (CNS) constitute benign circumscribed lesions that are more common in lateral than in midline sites. Epidermoid cysts of the CNS arise more frequently in the cerebellopontine angle, around the pons, near the sella, within the temporal lobe, in the diploe, and in the spinal canal. Most common tumoral lesion of sellar region is pituitary adenoma, and sellar cystic epithelial masses may be difficult to differentiate based only on clinical and imaging findings. Epidermoid cysts are covered by keratinized squamous epithelium and are usually filled with keratin lamellae. The process is, for the most part, maldevelopmental in origin, presumably arising from trapped surface ectodermal elements in association with the developing CNS during the closure of the neural groove or formation of the secondary cerebral vesicles. In the present study, the authors describe a case of sellar epidermoid cyst producing endocrine alterations and visual disturbance in a 35 years woman, and review the physiopathological and diagnostic criteria of this lesion.

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Cystic Lesions

Weis¹,

Sonnberger²,

Dunzinger³

et al. 2019

Imaging Brain Diseases

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Predictors of Outcomes in Fourth Ventricular Epidermoid Cysts: A Case Report and a Review of Literature

Cited by 7 publications

References 37 publications

Fourth ventricular epidermoid cyst – Case series, systematic review and analysis

Fourth ventricular epidermoid cyst – Case series, systematic review and analysis

Physiopathological Aspects of Sellar Epidermoid Cyst Determining Endocrine Disturbances: A Case Report

Cystic Lesions

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